Menstruation after sterilization of a woman. Female sterilization - sterilization of the fallopian tubes. Sterilization of women: consequences

A woman can become pregnant if a man's sperm fertilizes an egg. Contraception interferes with this by preventing the "meeting" of the egg and sperm, or by stopping the production of eggs. One method of contraception is female sterilization.

Female sterilization is usually done under general anesthesia, but may be done under local anesthesia, depending on the method used. The operation involves ligating, blocking, or coagulating the fallopian tubes, which connect the ovaries to the uterus.

Sterilization of the fallopian tubes of a woman prevents the fusion of the sperm and egg, that is, fertilization. The eggs will still be released from the ovaries as usual, but they will be absorbed naturally into the woman's body.

Facts about female sterilization

• In most cases, female sterilization is more than 99% effective, and only one in 200 women can become pregnant after sterilization.
• You don't have to think about the consequences of female sterilization every day, or every time you have sex - it doesn't affect your sex life.
• Tubal sterilization can be done at any stage of the menstrual cycle. The procedure will not affect hormone levels.
• You will still have periods after spaying.
• You will need to use contraception before your sterilization surgery and until your next period or for three months after your female sterilization (depending on the type of sterilization).
• As with any surgery, there is a small risk of complications after female sterilization. These include internal bleeding, infection, or damage to other organs.
• There is a small risk that the operation to sterilize the fallopian tubes will not work right away, or the tubes will begin to function years later. But this is the least likely.
• If the operation is not successful, it can increase the risk of an ectopic pregnancy (when a fertilized egg is outside the uterus, usually in the fallopian tube).
• The operation of female sterilization is almost irreversible, although the possibility of restoring the patency of the fallopian tubes does exist. This is an expensive procedure that is not done in every medical facility and is usually based on tubal plasty. The probability of conceiving a child according to most studies after the restoration of patency of the fallopian tubes is 60-70%.
• Female sterilization does not protect against sexually transmitted infections (STDs), so always use a condom after sterilization to protect yourself and your partner.

How female sterilization works

Female sterilization works by preventing eggs from "traveling" down the fallopian tubes. This means that the woman's egg cannot "meet" the sperm, which rules out fertilization.

How is female sterilization performed?

There are three main methods of female sterilization.

Laparoscopic sterilization of the fallopian tubes

Laparoscopic sterilization of the fallopian tubes through small punctures of the anterior abdominal wall using a special camera and microinstrument. Advantages of the laparoscopic procedure: minimally invasive, good aesthetic result, short rehabilitation period and low trauma - laparoscopic sterilization of the fallopian tubes is quite easily tolerated by patients. However, this procedure is considered expensive.

Minilaparotomy sterilization of the fallopian tubes

Minilaparotomic sterilization of the fallopian tubes is carried out by a small incision in the anterior abdominal wall (just above the pubic bone) about 3-5 cm long. Pros: minimally invasive, short rehabilitation period, low cost. Mini-laparotomy sterilization of the fallopian tubes is actually not inferior to laparoscopic sterilization, but at the same time it is more budgetary.

Colpotomy sterilization of the fallopian tubes

Colpotomy sterilization of the fallopian tubes is performed by incision of the vaginal fornix, but without affecting the abdominal wall. The advantages of colpotomy sterilization of the fallopian tubes: the complete absence of cosmetic defects, general availability and relatively low cost.

You must continue to use contraception until an imaging test confirms that your fallopian tubes are blocked. This can be done using procedures such as:

• hysterosalpingogram
• contrast sonography

Fallopian tube removal (salpingectomy)

If sterilization of the fallopian tubes has been unsuccessful, the fallopian tubes may be completely removed. The removal of the fallopian tubes is called a salpingectomy.

Video: how female sterilization is done

Preparation for female sterilization

Your doctor will definitely conduct several consultations before referring you to tubal sterilization. Ideally, this decision should be made by you and your partner, if appropriate and acceptable. If possible, you must both agree to the procedure, but by law, female sterilization does not require the consent of the husband or partner.

A consultation with a doctor will give you the opportunity to talk about the operation in detail, resolve any doubts and answer all questions.

Your doctor has the right to refuse a procedure or refuse a referral for surgery if he or she does not believe that female sterilization is in your best interest.

If you choose to be sterilized, you will be asked to use contraception until the day of the operation, and to continue using it:
until your next period if your fallopian tubes are blocked (tubal occlusion)
within about three months if you have uterine implants (hysteroscopic sterilization)

Female sterilization can be performed at any stage of the menstrual cycle.

Before you have surgery, you need to take a pregnancy test to make sure you are not pregnant. This is very important because when your surgeon blocks your fallopian tubes, there is a high risk that any pregnancy will be ectopic (when a fertilized egg grows outside the uterus, usually in the fallopian tubes). An ectopic pregnancy can be life-threatening because it can lead to severe internal bleeding.

Recovery after female sterilization

After you have recovered from the anesthetic, you will be allowed to go home. If you are released from the hospital a few hours after your tubal sterilization, ask a relative or friend to drive you home or call a taxi.

Your doctor should tell you what to expect and how to take care of yourself after surgery. He can give you a contact number to call if you have any problems or any questions.

If you have had a general anesthetic, you should not drive for 48 hours after it because the reaction time is not normal.

How will you feel after tubal sterilization?

It is normal to feel ill and a little uncomfortable for a few days, if the operation was performed under general anesthesia, you may need to rest for a few days. Depending on your general health and your job, you may be able to return to work five days after female sterilization. However, you should avoid heavy lifting for a week.

After tubal sterilization, there may be some minor vaginal bleeding. Use a sanitary napkin, not a tampon. You may also feel some pain, similar to period pain. The doctor may prescribe painkillers. If pain or bleeding gets worse after female sterilization, see your doctor.

How to have sex after female sterilization

• Your sexual desire and enjoyment of sex will not be affected. After tubal sterilization, you can have sex as soon as your condition returns to normal after the operation.
• If you have had a tubal occlusion, you will need to use contraception before your first period to protect yourself from pregnancy.
• If you have had a hysteroscopic sterilization, you will need to use another form of contraception for approximately three months after the operation.
• Once imaging tests confirm that the implants are in the correct position, contraceptives will no longer be required.
• Sterilization will not protect you from STDs, so continue to use barrier methods of contraception such as condoms if you are unsure about your partner's sexual health.

Who is female sterilization suitable for?

Almost any woman can be sterilized. However, sterilization should only be considered for women who do not wish to have any more children, or who do not wish to have children at all. It is very difficult to reverse the process after tubal sterilization, so it is important to consider other options before making a decision. Restoring the patency of the fallopian tubes after their sterilization is not done under an insurance policy - this is an expensive operation that you will have to pay for yourself.

Surgeons are more willing to perform sterilization when a woman is over 30 and has a child, although some younger women who have never had a child choose this procedure.

Advantages and disadvantages of female sterilization

Benefits of female sterilization

• female sterilization is 99% guaranteed to prevent pregnancy
• tubal occlusion (blockage of the fallopian tubes) and removal of the fallopian tube (salpingectomy) are effective immediately - however, doctors strongly recommend continuing to use contraception until the next period
• hysteroscopic sterilization is usually effective after about three months - studies have found that the fallopian tubes are obstructed after three months in just 96% of sterilized women.

Other benefits of female sterilization are as follows:

• female sterilization has no long-term negative effect on sexual health
• female sterilization does not affect sex drive
• female sterilization does not affect the spontaneity of intercourse and does not interfere with sex (other forms of contraception may)
• female sterilization does not affect hormone levels

Disadvantages of female sterilization

• Female sterilization does not protect you from sexually transmitted diseases, so you should still use a condom if you are not aware of your partner's sexual health
• It is very difficult to reverse a tubal occlusion - the operation involves removing the blocked part of the fallopian tube and joining the ends, and repairing tubal patency is rarely done free of charge.
• Approximately 1 in 50 women who have undergone hysteroscopic sterilization need further surgery due to complications such as persistent pain

Risks of female sterilization

Female sterilization has a very small risk of complications, including internal bleeding and infection or damage to other organs.
tubal sterilization can fail - the fallopian tubes can "work" again and return fertility, although this is rare (about one in 200 women becomes pregnant during their lifetime after sterilization)

If you become pregnant after being spayed, there is an increased risk that it will be an ectopic pregnancy

• Hysteroscopic sterilization has a small risk of pregnancy even after your tubes have been blocked. Research data has shown that possible complications after uterine implants may include:
• pain after surgery - in one study, almost eight out of 10 women reported pain
• implants are inserted incorrectly - this happens in two out of 100 women
• bleeding after surgery - many women had light bleeding after surgery, with almost a third bleeding for three days.

Denial of responsibility: The information provided in this article on female sterilization is intended to inform the reader only. It cannot be a substitute for the advice of a health professional.

Sterilization is used to deprive a person of the ability to reproduce offspring. Surgical sterilization, as the most effective method of contraception, is used in the treatment of various diseases, for birth control, and also as a coercive measure of punishment for the atrocities committed.

Around the world, more women are using tubal sterilization and vasectomy than other methods of contraception.

Sterilization of the fallopian tubes, although it is a very effective method, but there is still a risk pregnancy depending on the age of the person.

Regular intake of birth control pills has an adverse effect on the female body.

Today, the most effective method of birth control is considered tubal ligation, because after the successful completion of this procedure, a woman practically cannot become pregnant anymore.

Sterilization of women is mainly carried out under general anesthesia however, depending on the method used, it can also be performed under local anesthesia.

Surgery involves sealing or blocking the fallopian tubes that connect the ovaries to the uterus.

Consequences: when the sperm reaches the female egg, fertilization becomes impossible.

1. The effectiveness of female sterilization in most cases is 99% and only one in 200 is pregnant, even if surgery is performed.

2. Not worth it think about it every day, every time during sex, since sterilization cannot interrupt or affect the sexual life of partners.

3. The procedure can be carried out even during menses. It does not affect hormone levels.

4. Sterilization does not disrupt the menstrual cycle.

5. In any case, after the operation, you will not need to use contraceptives: neither until the next menstruation, nor within three months after it. It depends on the type of sterilization.

6. During surgery, various complications may occur: infectious diseases, internal hemorrhage or damage to neighboring organs.

7. Also exists risk that the operation will not work: the fallopian tubes may recover immediately or years later.

8. After an unsuccessful operation, the risk increases ectopic pregnancy, when the fertilized egg is outside the uterus.

9. Sterilization operation is hard to turn back.

10. female sterilization does not protect from various sexually transmitted infections. Therefore, in order to protect yourself and the health of your partner, it is necessary to use a condom during intimacy.

How sterilization works

Female sterilization is designed to prevent the egg from traveling down the fallopian tubes. This means that the sperm cannot meet the egg, and as a result, it is not fertilized.

How is female sterilization performed?

Exist two main types of female sterilization:

For many women, these surgeries are minor. Often, tubal occlusion is used.

Tubal occlusion

First of all, the surgeon must perform a mini-laparotomy or laparoscopy in order to view and check the fallopian tubes. Mini-laparotomy involves the implementation of a small less 5 cm(about two inches) incision made just above the pubic hair. Through the incision made, the surgeon can easily examine the fallopian tubes.

Laparoscopy is the most common method for accessing the fallopian tubes. The surgeon makes a small incision in the abdomen near the navel and inserts a small, flexible tube called a laparoscope equipped with a tiny light and a camera. The camera displays an image of the insides of the body on a television monitor. This allows the surgeon to see the fallopian tubes more clearly.

Laparoscopy is the preferred method of female sterilization as it is faster than mini-laparotomy. However, the last type of sterilization is recommended for women:

• who have recently been exposed to a pelvic or abdominal surgery
• suffering redundant weight, that is, their body mass index exceeds 30 kg
• who have undergone various inflammatory diseases pelvic organs, because the infection can have an adverse effect not only on the fallopian tubes, but also on the uterus itself

Pipe blocking

The fallopian tubes can be blocked using one of the following methods:

• special titanium or plastic clips used to clamp the fallopian tubes
• usage rings involves the implementation of a small loop of the fallopian tube, which is threaded through it
• binding or cutting the fallopian tube

Uterine implants (hysteroscopic sterilization)

The National University of Health and Welfare has published guidelines for hysteroscopic sterilization. In the UK, hysteroscopy is performed using the Essure technique. Implants are placed under local anesthesia. Along with this, you can also take a sedative.

A narrow tube with a telescope at the end, called a hysteroscope, is inserted into the vagina and cervix. A wire is used to insert a tiny piece of titanium into the hysteroscope and then into each fallopian tube. During the procedure, the surgeon does not need to make an incision in the female body.

The implant causes formation around the fallopian tubes scar tissue, which subsequently blocks them.

You should worry about using contraceptives until there is visual confirmation that your fallopian tubes are blocked. This can be done using the following methods:

• hysterosalpingogram (HSG) - an X-ray examination in which the uterine cavity is examined. This method involves the introduction of a special dye in order to show the fallopian tubes
• contrast hysterosalpingosonography – a type of ultrasound that uses dyes to be injected into your fallopian tubes

Salpingectomy (fallopian tube removal)

Incorrectly performed operation on the fallopian tubes can lead to their complete removal. This procedure is called a salpingectomy.

woman before surgery

Before a sterilization operation is performed, a woman should consult a doctor.

This will provide an opportunity to talk in detail about the operation, what questions, doubts and fears most often arise during it.

If a woman agrees to undergo sterilization, then the doctor sends her for treatment to the nearest medical institution to a gynecologist - a specialist in the field of the female reproductive system.

If you have chosen sterilization, you will be asked to use contraception before and after the operation:

Sterilization can be performed at any stage of your menstrual cycle.

Before the operation, you will need to take a pregnancy test to make sure that it is not. This is very important, as if the fallopian tubes are blocked, there is a high risk that the pregnancy may be ectopic.

An ectopic pregnancy can be life threatening as it can cause severe internal bleeding.

woman after surgery

After the termination of the anesthesia, you need to pass urine for analysis, eat a little, after which you will be allowed to go home. In the medical institution where the operation took place, they will tell you what to expect and how to care for yourself after sterilization, they will leave their contact number so that you can call if you have any problems, questions.

Pros and cons

Advantages:

• Sterilization in 99% helps to avoid unwanted pregnancy.
• Blocking or removal of pipes is in effect immediately.
• Hysteroscopic sterilization is usually effective after three months.
• Does not render influence on the health of a woman, her erogenous zones and the sexual intercourse itself.
• Does not affect to the hormonal level.

Flaws:

• Does not protect against sexually transmitted diseases.
• It is difficult to repair blocked fallopian tubes.

Side effects and consequences

1. With obstruction of the fallopian tubes, there is a risk of complications - infections, internal bleeding and damage to other organs.

2. After sterilization, a failure may occur: the fallopian tubes will connect, and you will be able to again get pregnant.

3. If you become pregnant after the operation, there is a risk that it will ectopic.

A bit of history

The ancient Egyptians practiced surgical sterilization of women, consisting in the destruction of ovarian tissue with a thin wooden needle. In the East, the sterilization of eunuchs, the caretakers of the harems of the sultans, has long been used, and in later times there were sects that used the sterilization of women and men for various purposes.

Excursion to physiology

The uterus is a pear-shaped hollow muscular organ. Fallopian tubes depart from the lateral surfaces of the bottom of the uterus. The other end of each tube is adjacent to the ovary. The body of the uterus has a triangular shape, gradually narrowing towards the cervix. Thus, the uterine cavity has the form of a triangle with the apex facing downwards. The cervical canal approaches the top of this triangle from below, and the fallopian tubes adjoin the region of the corners located in the upper part of the triangle.

Spermatozoa from the vagina enter the cervical canal, then into the uterine cavity, and after that into the fallopian tubes. It is in the fallopian tube that the egg is fertilized by the sperm. After fertilization, the embryo, due to contractions of the fallopian tube, enters the uterus back, where it attaches to its wall. There, the development of the fetus takes place until the moment of birth.

How is sterilization performed?

The essence of the operation of female sterilization is that the patency of the fallopian tubes is violated by various methods.

Previously, for sterilization, an incision was made in the abdominal cavity, in which the surgeon found the fallopian tubes. Then they were ligated. And then the fallopian tubes were cut between two threads. This technique was quite simple and reliable, spontaneous restoration of patency (recanalization) occurred extremely rarely. The success rate of the method was 99.5% or more, i.e. the patency of the fallopian tubes, depending on the technique, was restored on average in 2 cases per 1000 operations, i.e. in 0.2% of patients.

However, this method had a significant drawback: the operation required an opening of the abdominal cavity, so most often they were performed not independently, but as the second stage of any operation on the abdominal cavity - caesarean section, etc. After all, you must admit, not every woman will decide to do an abdominal operation for a similar purpose.

Currently, such operations are performed by the laparoscopic method: through 3 small punctures, a miniature video camera and special small-sized endoscopic instruments are inserted into the abdominal cavity. Surgical sterilization is carried out in a gynecological hospital.

There are two main methods of laparoscopic sterilization: electrocoagulation (cauterization) and mechanical blockage of the fallopian tubes.

In the first case, the pipe is cut with an electrocoagulator or captured with electric tweezers so that the walls of the pipe stick together under the influence of current and become impassable.

In the second method, mechanical sterilization is performed according to the following method: A ring is put on the fallopian tube from the outside or, 2-3 cm away from the corner of the uterus, two clips are applied. The pipe between them is crossed. Clipping without crossing is less reliable, since it is possible to cut through the clip and recanalize the tube. The duration of the operation, depending on the methods and techniques, ranges from 10 to 20-30 minutes. Contraindications - extensive adhesions of the abdominal cavity and small pelvis, which complicate the operation, and the presence of large fat deposits, which can also interfere with laparoscopy.

After operation

A complication of anesthesia can be aspiration (inhalation) of vomit. Rarely, complications such as injuries to the abdominal organs and small pelvis during surgery, inflammatory complications after surgery, and adhesions are rare.

The patient is allowed to get up by the end of the first day, then feeding begins. Drug therapy in the normal course is not prescribed. The hospital period after the operation lasts 1-3 days.

Sterilization as a method of contraception is characterized by high reliability. However, it must be understood that sterilization is a conditionally irreversible process.

One more important point should be noted. Many confuse sterilization with castration - an operation in which the function of the ovaries is somehow "turned off", the production of sex hormones is disrupted. This does not happen during sterilization.

If the operation was successful, then there should not be any additional changes in the body, except for the lack of the ability to conceive.

What does the law say?

The law clearly defines the conditions under which sterilization can be carried out. Let us turn to the Fundamentals of the Legislation of the Russian Federation on the Protection of the Health of Citizens, adopted on July 22, 1993, Section VII (“Medical Activities for Family Planning and Regulation of the Human Reproductive Function”). Article 37 of this law reads: “Medical sterilization as a special intervention to deprive a person of the ability to reproduce offspring or as a method of contraception can only be carried out upon a written application of a citizen not younger than 35 years old or having at least two children, and if there are medical indications and consent citizen - regardless of age and the presence of children. The list of medical indications for medical sterilization is determined by the Ministry of Health of the Russian Federation.”

Indications for sterilization are listed in the order and include 55 diseases. These indications are established by a commission consisting of at least 3 specialists: an obstetrician-gynecologist, a doctor of the specialty in which the patient's disease belongs, and the head of a healthcare institution. Medical sterilization of persons declared incompetent and suffering from mental illness is carried out only on the basis of a court decision. The patient must understand that the restoration of patency of the fallopian tubes after any method of sterilization cannot be guaranteed. Therefore, a woman, before deciding on this operation, should clearly determine for herself that she does not want to give birth anymore.

However, the irreversibility of fertility restoration is relative. If a woman suddenly wishes to have children again, it is possible to carry out the so-called plastic surgery of the fallopian tubes - the restoration of their integrity and patency using a special method. The success rate of recovery is 60-80%.

In addition to restorative operations, women are offered in vitro fertilization. In this case, the egg is first taken from the ovary, and then the embryo is introduced into the uterine cavity. In this case, n-passable fallopian tubes will not interfere with pregnancy.

Pros and cons

The sterilization method naturally has both advantages and disadvantages.

The disadvantages include the above-mentioned relative irreversibility of the procedure. But this method has many advantages. One of them is that a single procedure saves a woman from contraceptive problems, and for many women after 35 this is a serious problem. Children are no longer small, they want to live a full life, but there are already serious restrictions in terms of using, for example, hormonal contraceptives or intrauterine devices. Indeed, by this time, a woman often accumulates a whole “bouquet” of diseases, including thrombophlebitis, chronic diseases of the pelvic organs. And for many, sterilization is an opportunity to live sexually without fear of unwanted pregnancy.

New Methods

Recently, a new, simpler and safer method of female sterilization has been developed, which does not require surgery and entry into the abdominal cavity. Its essence is that various drugs or devices introduced into the uterus cause, for example, local tissue damage with an inflammatory response. The site of damage grows with connective tissue, and the fallopian tubes are blocked.

For example, the development of the Australian company Conceptus called Essure is a microcoil with a special thread. These are micro-inserts that are inserted into the fallopian tubes and disrupt their patency.

Essure is administered without abdominal surgery, under local anesthesia. A hysteroscope is inserted into the uterus through the vagina - a type of endoscope designed to work in the uterine cavity. Under visual control, a microinsert is inserted into each fallopian tube.

Over time, connective tissue grows through them, so that the fallopian tubes become impassable for spermatozoa, and, accordingly, fertilization does not occur.

It takes 15 minutes to process each fallopian tube. On the same day, the patient can go home.

Large-scale studies have shown that the effectiveness of this method is more than 99%. 92% of women return to their normal activities within one day or even earlier, although they have to see a doctor again after three months.

It takes about three months for the device to germinate with connective tissue and completely block the fallopian tube, after which a control X-ray is performed, and, if necessary, an X-ray examination with a contrast agent. With such a study, it is possible to draw an accurate conclusion about the patency of the tubes, since it turned out that in 2.5% of cases the protection is not enough and the fallopian tubes partially retain patency.

However, given the simplicity and safety of the operation, it can be assumed that it has good prospects.

Voluntary surgical sterilization(DHS), or as it is also called tubal occlusion- This is a method of contraception in which obstruction of the fallopian tubes is artificially created and an irreversible cessation of female reproductive function occurs. Currently, DHS is a common method of birth control in many countries of the world.

Mechanism of action

During the operation, the fallopian tubes are tied up, crossed or clamps (brackets, rings) are applied to them. Electric cauterization is also possible. After this procedure, the meeting of the egg and sperm is excluded due to an obstacle artificially created in their path. The contraceptive effect is achieved immediately after surgery.

Surveys

Before the operation, the patient undergoes an examination: gynecological examination, taking smears from the vagina and cervix to determine the microbial flora, as well as to exclude oncological diseases; ultrasound examination (ultrasound) of the pelvic organs to exclude pregnancy and tumor processes of the uterus and ovaries; electrocardiogram (ECG); general analysis of blood and urine; blood chemistry; blood tests for syphilis, AIDS, hepatitis B and C; therapist examination. As a result of the examination, all possible contraindications to the operation are revealed. If they are identified, a conclusion is made about the possibility and / or expediency of using another reliable method of contraception.

About the operation

While doing laparotomy the surgeon makes an incision (about 20 cm) that provides access to the organs on which the operation is performed. In this case, tissues are injured, pain occurs after surgery, the wound healing period takes quite a long time, the scar can be significant. After an open surgical intervention in the abdominal cavity, complications are possible and pronounced adhesions are formed (growth of connective tissue in the form of strands). Laparoscopic technique eliminates the need to make large incisions. The surgeon performs 3-4 skin incisions (about 1 cm), after which soft tissue punctures are made here with a special hollow instrument and the instruments necessary for laparoscopic surgery and an optical device with a mini-video camera - a laparoscope are inserted into the abdominal cavity; the image is transmitted to the monitor screen, the surgeon sees the internal organs and all manipulations are carried out under visual control. Be sure to inflate the abdominal cavity with carbon dioxide, as a result of which the abdominal wall rises and provides the best access to the internal organs. After the operation, the patient experiences less pain, subtle scars remain on the skin, the restoration of normal life is faster, there are fewer complications, and the formation of adhesions in the abdominal cavity is minimized. Laparotomy is performed for medical reasons or during a caesarean section, gynecological surgery for another reason, free of charge. Laparoscopy is always carried out for a fee. With severe obesity in a patient, the laparoscopic technique is not used for operations on the abdominal cavity. In addition, when the abdominal cavity is inflated with carbon dioxide, there is a risk of gas bubbles entering the blood vessels, which can lead to gas embolism - blockage of a large vessel with a similar bubble and impaired blood circulation in tissues and organs. In the worst case, this leads to death. Sterilization is carried out only in a hospital under general anesthesia. The duration of the operation is 15-20 minutes. Discharge from the hospital, in the absence of complications, is carried out depending on the technique on days 2-3 (with laparoscopy) or 7-10 days (with laparotomy), respectively. The rehabilitation period is up to 7 days or up to 1 month.

Benefits of Tubal Occlusion

• High efficiency (0.01 pregnancy per 100 women).
• Quick effect, the procedure is carried out once.
• Permanent method of contraception.
• No effect on breastfeeding.
• Lack of connection with sexual intercourse.
• Suitable for patients whose health is at serious risk of pregnancy (for example, heart defects, chronic active hepatitis with signs of liver failure, a single kidney, the presence of malignant neoplasms of any localization, repeated caesarean section in the presence of children, etc.).
• No long-term side effects.
• Does not reduce sex drive.

Disadvantages of tubal occlusion

• The method of contraception is irreversible. The patient may later regret her decision.
• The need for short-term hospitalization for 5-7 days.
• There is a risk of complications associated with surgery and anesthesia.
• Short-term discomfort, pain after surgery for 2-3 days.
• High cost of laparoscopy. Does not protect against sexually transmitted diseases and AIDS.

Who can use tubal occlusion

• Women over 35 or with 2 or more children:
  • who give voluntary informed consent to the procedure (when choosing this method of contraception, the married couple should be informed about the features of the surgical intervention, the irreversibility of the process, as well as possible adverse reactions and complications. The legal side of the issue requires mandatory documentation of the patient's consent to DHS );
  • who want to use a highly effective irreversible method of contraception;
  • after childbirth;
  • after an abortion;
• Women for whose health pregnancy is a serious danger.

Who Should Not Use Tubal Occlusion

• Women who do not give voluntary informed consent to the procedure.
• Pregnant women (established or suspected pregnancy).
• Patients with spotting for which the cause is unclear (before diagnosis).
• Women suffering from acute infectious diseases (until cured).
• Women who have a bleeding disorder.
• Women who have recently had open abdominal surgery (for example, on the abdomen or chest).
• Women for whom surgery is unacceptable.
• Women who are unsure of their intentions regarding future pregnancies.

When to perform a tubal occlusion

• From the 6th to the 13th day of the menstrual cycle.
• Postpartum 6 weeks later.
• After an abortion immediately or within the first 7 days.
• During a caesarean section or gynecological operation.

Complications of tubal occlusion

• Infection of the postoperative wound.
• Pain in the area of ​​the postoperative wound, hematoma.
• Bleeding from superficial vessels, intra-abdominal bleeding.
• An increase in body temperature above 38 ° C.
• Injury to the bladder or intestines during surgery (rare).
• Gas embolism during laparoscopy (very rare).
• Risk of ectopic pregnancy due to incomplete occlusion of the fallopian tubes (rare).

Instructions for Patients

• The postoperative wound should not be wetted for 2 days.
• Daily activities should be resumed gradually (normal activity is restored on average within a week after surgery).
• You should refrain from sexual intercourse for a week.
• You can not lift weights and do hard physical work during the week.
• Painkillers can be taken if pain occurs ANALGIN, IBUPROFEN or PARACETAMOL) every 4-6 hours, 1 tablet.
• You need to go to the doctor to remove the stitches in a week.
• 10 days after the operation, you should come to the gynecologist for a follow-up examination.

Seek immediate medical attention if after surgery:

• the temperature increased (38 ° C and above), chills arose;
• dizziness, fainting;
• disturbed by constant or increasing pain in the lower abdomen;
• wetting of the bandage with blood is observed;
• there are signs of pregnancy.

• It is a permanent method of contraception for women who no longer plan to give birth.
• There are two most common methods of surgical sterilization of women:
  • Minilaparotomy (performed by making a small incision in the abdominal wall) with the fallopian tubes pulled up to the incision and then transected or ligated.
  • Laparoscopy (insertion of a long thin tube equipped with a lens system into the abdominal cavity through a small incision) with the intersection or ligation of the fallopian tubes under the visual control of the surgeon.
• Also known as tubal sterilization, voluntary surgical contraception, tubectomy, tubal ligation, minilaparotomy, and surgery.
• The mechanism of action is to block the lumen of the fallopian tubes by tying or crossing them. The eggs released from the ovaries cannot move through the fallopian tubes and, accordingly, come into contact with sperm.

What is the effectiveness of the method?

Female sterilization is included in the group of the most reliable methods of contraception, while not providing a 100% contraceptive effect:

• During the first year after sterilization, there is less than 1 unplanned pregnancy per 100 women (5 cases per 1,000 women). This means that 995 out of 1,000 women who undergo surgical sterilization will achieve the desired effect (prevention of pregnancy).
• A slight risk of an unplanned pregnancy continues to persist after the first year after sterilization (up to the onset of menopause).
  • Within 10 years after sterilization: about 2 cases of unplanned pregnancy for every 100 women (from 18 to 19 cases per 1000 women).
• Although the severity of the contraceptive effect is subject to slight fluctuations depending on how the lumen of the fallopian tubes was blocked, nevertheless, the risk of an unplanned pregnancy is very low when using any method of sterilization. One of the most effective sterilization techniques involves cutting and ligating the cut ends of the fallopian tubes after childbirth (postpartum tubal ligation).

Fertility Restoration does not occur, since it is usually impossible to suspend or reverse the contraceptive effect of sterilization. The method provides for the onset of a persistent contraceptive effect. Tubal repair surgery is a complex and expensive procedure that can only be performed in some medical centers and rarely has the desired effect (see question 7, at the end of this page). Protection against sexually transmitted infections (STIs): Not provided.

Side effects, benefits and possible health risks

Who can use the female sterilization method?

The method is safe for any woman, subject to qualified preliminary consultation work with the patient and her conscious choice based on complete information, almost any woman can undergo surgical sterilization, including:

• Women who have not given birth and women who have few children
• unmarried women
• Women who do not have a spouse's permission to sterilize
• young girls
• Women in the early postpartum period (up to 7 days after childbirth)
• breastfeeding women
• HIV-infected women and women receiving and responding to antiretroviral treatment (see "Female sterilization and HIV infection" down the page)

In certain circumstances, competent counseling work with the patient is of great importance, the purpose of which is to keep the woman from making a hasty decision, which she may later regret bitterly (see "Irreversible effect of sterilization", down the page).

Female sterilization can be done:

Sterilization procedure

Surgical sterilization

Informing the patient about the content of the procedure

A woman who decides to undergo sterilization must have a clear understanding of the procedure for performing the operation. For this purpose, you can use the description below. Mastering the technique of sterilization requires appropriate training under the direct supervision of an experienced specialist. Accordingly, this description is of a summary nature and cannot be considered as a practical guide.

(The following description is for the procedure performed after 6 weeks postpartum. The procedure for sterilization performed within 7 days postpartum has some peculiarities.)

Minilaparotomy

1. At all stages of the operation, appropriate measures are taken to prevent infections (see).
2. The doctor conducts a general and gynecological examination (the purpose of the latter is to determine the size and mobility of the uterus).
3. The woman is given a small dose of a sedative (by mouth or intravenously). However, she remains fully conscious. The area above the pubic hairline is subjected to local anesthesia (injection).
4. The surgeon makes a small transverse incision (2-5 cm long) within the anesthetized area. In this case, a woman may feel a slight pain. (In cases where we are talking about a woman who has recently given birth, a longitudinal incision is made just below the navel).
5. The surgeon inserts a special instrument (lifter) into the vagina, passes through the cervix into the uterine cavity, and then alternately lifts each of the two fallopian tubes so that they are close to the incision in the abdominal wall. When performing these actions, a woman may experience discomfort.
6. The tubes are alternately tied and crossed, or clamped with special brackets or rings.
7. Surgical sutures are applied to the incision, and the area of ​​the sutures is closed with an adhesive bandage.
8. The woman is given recommendations for care in the postoperative period (see "Recommendations for care in the postoperative period", down the page

Laparoscopy

1. At all stages of the procedure, appropriate measures are taken to prevent infections (see "Prevention of nosocomial infection").
2. The doctor conducts a general and gynecological examination (the purpose of the latter is to determine the condition and mobility of the uterus).
3. The woman is given a small dose of a sedative (by mouth or intravenously). However, she remains fully conscious. The area below the navel is subjected to local anesthesia (injection).
4. The surgeon inserts a special needle into the woman's abdomen and injects a certain amount of air or gas into it. This allows you to take the abdominal wall to a sufficient distance from the pelvic organs.
5. The surgeon makes a small incision (about a centimeter long) within the anesthetized area and inserts a laparoscope, which is a long thin tube with a lens system, into the abdominal cavity. Using a laparoscope, the surgeon examines the abdominal organs and locates the fallopian tubes.
6. The surgeon inserts a special instrument into the abdominal cavity through a laparoscope (sometimes the instrument is inserted through an auxiliary incision) and clamps the fallopian tubes.
7. Each pipe is pinched with a bracket or ring. There is also a technique for blocking the lumen of the fallopian tubes using electric current (electrocoagulation).
8. The surgeon removes the instrument and laparoscope from the abdomen and releases the previously pumped gas or air. Surgical sutures are applied to the incision, and the area of ​​the sutures is closed with an adhesive bandage.
9. The woman is given advice on post-operative care (see "Post-Op Care Recommendations" down the page). As a rule, a woman is able to leave the clinic within a few hours after the operation.

Surgical sterilization is preferably performed under local anesthesia.

Surgical sterilization should preferably be performed under local anesthesia (with or without a low dose of sedation) rather than under general anesthesia. Local anesthesia:

• Safer than general, spinal or epidural anesthesia
• Provides the possibility of early discharge from the clinic after surgery
• Provides the possibility of faster recovery in the postoperative period

Allows you to perform the procedure of female sterilization on the basis of a larger number of medical institutions

Sterilization under local anesthesia requires one member of the surgical team to be trained in the administration of sedatives and the operating physician to be able to administer local anesthesia. The surgical team must be prepared to deal with emergencies, and the medical facility itself must be equipped with the basic equipment and medicines needed to treat such conditions.

The doctor should explain to the woman in advance that maintaining consciousness during the operation improves the safety of the procedure. In this case, the surgeon can maintain verbal contact with the patient and, if necessary, encourage her.

A variety of painkillers and sedatives can be used for local anesthesia.

The dose of anesthetic is selected taking into account the woman's body weight. The use of large doses of anesthetic is not recommended due to the fact that it can cause overwhelming drowsiness in a woman and lead to slow or stopped breathing.

In some cases, however, it may be necessary to perform the operation under general anesthesia. The "Medical Criteria for the Acceptance of the Female Sterilization Technique" section indicates health conditions for which surgical sterilization can only be performed under special conditions, including general anesthesia.

User consultation

"Contact at any time": reasons for a second visit

Reassure the woman that if she needs your help again, you will be happy to see her at any time - for example, if she has any problems or questions about using this method of contraception, or if pregnancy is suspected. (In rare cases, if the operation fails, an unplanned pregnancy may occur). Also, a woman should come to the doctor's office in the following cases:

• Bleeding, pain, purulent discharge, local fever, swelling and hyperemia in the area of ​​the postoperative wound (symptoms become more pronounced or chronic)
• An increase in body temperature (above 38 ° C)
• In the first 4 weeks (especially during the first 7 days) after the operation, the woman experiences fainting, constant slight dizziness or very severe dizziness.

General advice: If a woman feels a sudden deterioration in her condition, she should immediately seek medical attention. Although it is very unlikely that this health problem can be caused by the method of contraception used, a woman should tell her health care provider about which method she uses.

Solving problems associated with the application of the method

Problems attributed by users to the category of postoperative complications

The occurrence of problems in the postoperative period reduces the woman's satisfaction with this method. Such situations call for appropriate action. If a woman reports any complications, listen carefully, help with advice and, if necessary, prescribe appropriate treatment.

• Wound infection (hyperemia, local fever, pain, purulent discharge)
  • Wash the affected area with soap and water or an antiseptic solution.
  • Advise the woman to return for a follow-up appointment if a course of antibiotic therapy does not give the desired effect.
• Abscess (encapsulated subcutaneous purulent formation of infectious etiology)
  • Treat the affected area with an antiseptic.
  • Open and drain the abscess.
  • Treat the wound.
  • Assign a 7-10-day course of antibiotic therapy (in tablets).
  • Advise the woman to return for a follow-up appointment if a course of antibiotic therapy does not give the desired effect (local fever, hyperemia, pain and purulent discharge from the wound persist).
• Severe pain in the lower abdomen (suspected ectopic pregnancy)
  • See "Treatment of an ectopic pregnancy" below.
• Suspicion of pregnancy
  • Get tested for possible pregnancy (including ectopic)

Treatment of an ectopic pregnancy

• An ectopic pregnancy is said to occur when the pregnancy begins to develop outside the uterine cavity. Early diagnosis of an ectopic pregnancy is important. An ectopic pregnancy is a fairly rare but very life-threatening condition (see question 11 down the page).
• In the early stages of an ectopic pregnancy, symptoms may be absent or mild, but subsequently their intensity increases dramatically. Some combination of relevant signs and symptoms should be suggestive of a possible ectopic pregnancy:
  • Abdominal pain or tenderness of an unusual nature
  • Abnormal vaginal bleeding or absence of monthly bleeding (this circumstance plays a special role in cases where the occurrence of these phenomena was preceded by regular menstrual cycles)
  • Vertigo of varying intensity
  • Loss of consciousness
• Interrupted ectopic pregnancy (rupture of the fallopian tube): The sudden onset of cutting or stabbing pain in the lower abdomen (which may be one-sided or diffuse) may indicate an interrupted ectopic pregnancy (a condition when the fallopian tubes rupture under the influence of a growing fetal egg). Irritation of the diaphragm by the blood that has poured out as a result of perforation of the fallopian tubes leads to the appearance of pain in the right shoulder. As a rule, within a few hours after perforation, a picture of an "acute abdomen" develops, and the woman goes into shock.
• Treatment: Ectopic pregnancy is one of the life-threatening conditions requiring immediate surgical treatment. If an ectopic pregnancy is suspected, a gynecological examination is allowed only in cases where there are conditions for urgent surgical intervention. In the absence of such conditions, the woman should be immediately sent (providing, if necessary, her transportation) to a medical institution where she can be provided with qualified assistance.

Female sterilization questions and answers

1. Can surgical sterilization affect the nature of monthly bleeding or lead to their cessation [show] ?

   No. The results of most studies indicate that surgical sterilization does not significantly affect the nature of monthly bleeding. If, before sterilization, a woman used a hormonal method of contraception or an IUD, then after the restoration of the menstrual cycle, his "pattern" returns to that which was observed in this woman before she began to use the hormonal method or IUD. For example, after sterilization, a woman who has previously used combined oral contraceptives may notice that her monthly bleeding becomes more intense as her regular menstrual cycle returns. It should be noted that monthly bleeding usually becomes less regular as a woman approaches menopause.

2. Can sterilization reduce sex drive? Can sterilization cause weight gain? [show] ?

   No. Sterilization does not affect the appearance or attitude of a woman. She can live a normal sex life. Moreover, a woman may find that she enjoys sex more because she no longer has to worry about getting pregnant. The sterilization procedure does not cause weight gain.

3. Should the category of persons to whom the method of surgical sterilization be offered be limited to women who have a certain number of children, have reached a certain age, or are married [show] ?

   No. A woman who wishes to undergo sterilization should not be denied such an operation just because of her age, number of children in the family or marital status. Family planning providers should not set rigid rules that make sterilization possible based on a woman's age, the number of births, the age of the youngest child in the family, or the woman's marital status. Every woman should have the right to make her own and independent decision regarding sterilization.

4. Is general anesthesia a more convenient and appropriate method of pain relief for both the woman and the physician? Why local anesthesia is preferred [show] ?

   Local anesthesia is a safer method of pain relief. General anesthesia can pose a greater danger to a woman's health than the sterilization operation itself. Proper administration of local anesthesia avoids the only major risk associated with the sterilization procedure - the risk of developing anesthetic complications. In addition, the post-anesthetic period is usually accompanied by a feeling of nausea, which rarely occurs after operations performed under local anesthesia.

   At the same time, when performing operations under local anesthesia using sedatives, a woman should not be "loaded" with excessive dosages of the drug. The surgeon must treat the woman with care and maintain a conversation with her throughout the operation. This helps her stay calm during the procedure. The use of sedatives can often be avoided, especially if the sterilization procedure was preceded by good counseling and the operation is performed by an experienced surgeon.

5. Should a woman who has undergone surgical sterilization continue to worry about becoming pregnant? [show] ?

   As a rule, no. Female sterilization is a very reliable method of contraception and is irreversible. However, the method is not completely efficient. After sterilization, a slight risk of pregnancy continues to persist. For every 1,000 women who were sterilized less than 1 year ago, there are about 5 cases of unplanned pregnancies. This risk continues to persist in the future - up to the onset of menopause.

6. Although pregnancy after surgical sterilization occurs in very rare cases, why does it still happen [show] ?

   In the vast majority of cases, such situations occur when the woman was already pregnant at the time of sterilization. Sometimes a hole can form in the wall of the fallopian tubes. Also, pregnancy can occur in cases where the surgeon mistakenly crosses not the fallopian tubes, but a formation similar in shape.

7. Is it possible to restore the ability to conceive after sterilization if a woman wants to have a baby [show] ?

   As a rule, no. Sterilization provides for the onset of a persistent contraceptive effect. Persons who admit the possibility that they will want to have a child in the future are advised to use another method of contraception.

   Surgical restoration of the patency of the fallopian tubes is theoretically possible only if the length of the tube segment remaining after sterilization is sufficient. At the same time, performing a reconstructive surgical operation does not give any guarantee that a woman will be able to become pregnant again. The operation to restore the patency of the fallopian tubes is a complex and expensive procedure, and the circle of specialists who own the technique of its implementation is limited. If pregnancy occurs after such an operation, then the likelihood that it will be ectopic is slightly higher than in other cases. Thus, surgical sterilization should be considered a method leading to permanent loss of fertility.

8. Which method is more preferable: female sterilization or vasectomy [show] ?

   Each couple must make their own decision as to which type of sterilization is more preferable for them. Both female sterilization and vasectomy are a very reliable, safe, permanent method of contraception for couples who know for sure that they will not have children in the future. Ideally, spouses should weigh the advantages and disadvantages of both methods. If both methods are acceptable for a given couple, then vasectomy is the method of choice because of the relative simplicity, safety, ease and cheapness of performance compared to female sterilization.

9. Is the sterilization procedure painful? [show] ?

   Yes, to some extent. The operation is performed under local anesthesia and, except in special cases, the woman is fully conscious during the procedure. A woman may feel the manipulation of the surgeon with the uterus and fallopian tubes, which may cause her discomfort. If the woman's pain threshold is very low, surgery under general anesthesia is allowed, provided that the surgical team has an anesthesiologist and the clinic has the appropriate equipment. A woman may feel pain or weakness for a few days or even weeks after the operation, but these symptoms subside with time.

10. How a doctor can help a woman make a decision about surgical sterilization [show] ?

    By providing clear and unbiased information about female sterilization and other methods of contraception, assisting in learning all aspects of the method, and jointly reviewing her position on motherhood and the prospect of being unable to conceive. For example, a doctor may suggest that a woman think about how she would feel in the event of a sudden change in life circumstances, including starting a new family or losing a child. Pay particular attention to highlighting the six building blocks of informed decision making (see above on page) to ensure that the woman is fully aware of the consequences of sterilization.

11. Does the risk of ectopic pregnancy increase after sterilization? [show] ?

    No. On the contrary, surgical sterilization significantly reduces the risk of ectopic pregnancy, which is an extremely rare occurrence among women who have undergone such a procedure. There are about 6 cases of ectopic pregnancy per 10 thousand women who underwent sterilization surgery per year. In the US, there are approximately 65 ectopic pregnancies per year for every 10,000 women who do not use one or another method of contraception.

    In those rare cases where the contraceptive effect of sterilization fails, 33 out of every 100 pregnancies (i.e. one in three) are ectopic. Thus, in the vast majority of cases, pregnancy resulting from a failure of the contraceptive effect of sterilization is not ectopic. However, since this condition poses a serious threat to the life of a woman, one should be aware of the possibility of an ectopic pregnancy after sterilization.

12. On the basis of which institutions can surgical sterilization be performed? [show] ?

    In the absence of diseases requiring the creation of an operation under special conditions:

    • Sterilization by the minilaparotomy method can be carried out on the basis of maternity hospitals and basic medical institutions, where there are conditions for performing surgical operations.

      This category includes both inpatient and outpatient facilities, from which a woman can be transferred to a specialized clinic in the event of conditions requiring emergency care.

    • Sterilization by laparoscopy can only be performed in clinics that have the appropriate equipment, where operations of this kind are performed regularly, and which have an anesthesiologist on staff.
13. What are transcervical sterilization methods? [show] ?

    Transcervical methods are based on a new method of access to the fallopian tubes - through the vagina and cervix. Clinics in some countries are already practicing the use of the new "Essure" tool, which looks like a microspring. In this case, the surgeon injects the agent (under visual control using a hysteroscope) through the vagina into the uterine cavity and then alternately into the fallopian tubes. Within 3 months after the procedure, scar tissue grows around the injected agent, which reliably blocks the lumen of the fallopian tubes and prevents the passage of spermatozoa through the tubes and their contact with the egg. However, the widespread use of this method in economically underdeveloped countries is unlikely due to its significant high cost and the complexity of working with an optical instrument used when introducing the "Essure" tool.